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Polypharmacy in the Elderly: A Prescription for Disaster

by Daria Ruffolo, DNP, RN, CCRN, ACNP-BC

Polypharmacy is defined by Webster’s Dictionary as “the practice of administering many different medicines especially concurrently for the treatment of a single disease” and “the concurrent use of multiple medications by a patient to treat usually coexisting conditions and which may result in adverse drug interactions.”

Healthcare providers encounter polypharmacy daily, with elderly patients taking 10, 12 or even 20 medications. These elderly patients are often unsure of the reasons for medications and overwhelmed by the dosing regimens, which often lead them to take medications haphazardly or not at all.

In turn, polypharmacy results in poor clinical outcomes and even additional medication therapy. Moreover, excessive use of medications increases the risk of side effects which are then misrecognized and treated with yet more medications.

It is estimated that 40% of people over the age of 65 use over 5 medications and engage in polypharmacy.

Polypharmacy doesn’t just frustrate patients. Providers frequently inherit an elderly patient with little medication history and constantly struggle to keep up with changes made during multiple hospital admissions or specialist visits. They are often pressured to follow clinical guidelines which can add additional medication therapies. When challenged with whether or not to stop a medication, providers worry about the risk of adverse events or whether or not it is wise to “rock the boat.”

Of course, every provider feels that they are prescribing only what is truly necessary. If an individual has an internist, a cardiologist, a gastroenterologist, an urologist and a dermatologist — which is not unusual — and each prescribes only 2 or 3 essential medicines, then polypharmacy is created. Each day, the patient swallows a myriad of chemicals all ripe for side effects and reactions.  Then they present back to their provider suffering from unexplained nausea, balance issues, confusion, dizziness, falls, bowel disturbances and abdominal pain and they may end up with yet another prescription thrown onto the equation.

What can seniors do to prevent this prescribing cascade? Patients and families can ask their physicians to review their list of medications and supplements and discuss whether to continue or change their regimens.

It is imperative that providers have a clear picture of all medications, supplements and treatments to prevent dangerous interactions.

Pharmacists, often underused as information sources, can help coordinate medications, and some patients qualify for medication reviews through Medicare. Good communication between elderly patients and their provider is the key to managing polypharmacy and keeping the elderly safe.

Unfortunately we function in a culture where every symptom demands a pharmaceutical response. We need to challenge our thinking as providers to verify that every drug is truly needed. Use the lowest dose that will accomplish the mission, communicate with all care providers and determine who is leading the charge on minimizing polypharmacy in our geriatric patients.


See Daria Ruffolo, DNP, RN, CCRN, ACNP-BC speak in 2018 at a Skin, Bones, Hearts & Private Parts conference in Destin, Orlando, or San Antonio.